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Home My Public Portal About5665 ROSEMEAD BLVD_Miscellaneous__ YORKERS'CO,^ll'ENSATION DF:CLARA1 ie4" r- 875 (2.80)a CE W SC E L LA N EO U S APPLICATION CE 87 i hereby affirm that I have a certificate of consent nc self COUNTY OF LOS ANGELES Tr C, BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a c�t' ledd�opy the eof(Sec.3800,Lab.C.) Polic .` �� ompanYf' w�.C6� BLfILDING FOR APPLICANT TO FILL IN ADDRESS d Certified copy is hereby furnished. BUILDING ; 1W S, � o LOCALITYy ADDRESS &4 Certified copy is filed with the county b i(d9ng inspegtion / NEAREST u de d e ! e`uAL / I �• 0CALITY '�v �L( t&' -C CROSS ST. turj pd 80-P zJW1 Date `S Applicant / NEAREST 4 DISTRICT N GROUP TJfPE PROLE SED BY CROSS ST. L3 ✓Mir)a. ��Lli t' ��►1'a �� ONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL rO COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAPdV 1m IIIc-H-A } NO. OF BLOCS. No. � (CIRCLE) STATE MAJOR SECOND LOCAL d (This section need not be completed if the Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars (5100) or less.) E USOF SIZE OF LOT EXISTING BLDG. C�� 1 certify that in the performance of the work for which this p permit is issued, I shall not employ any person in any manner OWNER AyS ljt 17 w:. r, so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP U.1 Date Applicant ADDRESS I`$�� t%) NOTICE TO APPLICANT: If, after making this Certificate of C.—S.,#") (J IT-" V 2-) Z OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. ❑ Y N UP OCCACINSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and Fe_7ZIE iAlf—C (Ye 7 PARKING. effect. J v SPACES ' REQ'D PROVIDED License Number Lic.Class oa 4 3� •3s i . krrlt LIMITED TIME USE Contractor Date 1 i p T O:oeAr ATE ❑ G J f S/ ` �G X FROM: V I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL ffffff �/1 PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 4,� 6 e SPACES PROVIDED 1-• 1, as owner of the property, will do the work and the 01 0.308 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1 0 7 ( r PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 0 5 3 1 -84 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE g 49=v4= ^ I certify that I have read this application and state that the �i 4,p above information is correct.I o e to comply with all County ISSUANCE FEE ordinances and State laws r at'tg to building construction, TOTAL FEE and h�th. cve-menti.neduthorire represent Ives of this Co to enter ,3 up ro err for inspec es. SEE RFVERSE FOR EXPLANATORY LANGUAGE L. s'•3/tiff Signature of Permittee Date I' \'dRI:ERS'CONIPEVSATIONDECL:\RaT1JN CE 875 111.841 MISCELLANEI US APPLICATION r- ' CE 7.�i "'Hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION '�, ' insure. or a certificate of Workers'Compensation Insurance.or fth.�kl a certified copy thereof(Sec. 3800.Lab.C.). 'I �''J Policy No. Company FOR APPLICANT TO FILL IN AOILDING DRE35 �lry Certified coy is hereby furnished. BUILDING e��S ! p• ' ADDRESS .,,J �l(�• LOCALITY I I i Certified copy is filed with Elie county buildinu inspection LOCALITY /+ 1 NEAREST department. Temple ll:y CROSS ST. Cor Date Applicant NEAREST ' DISTR If..T NCC GR P TYPE P CESSED BY I CROSS ST. `D CONST. I CERTIFICATE OF EXEMPTION FROM WORkERS LEGAL C9J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK ( I:VIAP HIGHWAY 1 1 NO. OF LDG3. ND. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not he completed if the work involved TRACT NON ONBLOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (Si00) or less.) -SE O 1 SIZE OF LOT IF EXISTING BLDG. I I certifv that in the performance of :lie%cork for•cinch -his permit is issued. I shall not employ any ?e-,son :n any manner OWNER Wl so as to become subject to Elie Workers' ContpensAtion Lacs. OCCUPANCYGROUP MAIL Date Applicant AO DR E35 3W i^' W 6L � �� • 5{Q, 130 1 • NOTICE TO APPLICANT: If. after makin!_ :!tis Certificate or $I CIT- Ifol SIT, L{�vg l -4. OCCUP4N- LOAD Exemption, you should become subject ro 'lie N%'nrkers' gpDLICATICN =�F. EXIT HARMIJAPE Compensation provisions of the Labor Code, you must forth- I�i ( with comply %%'ith inch pIovisioni or :his Permit ;Bail be _RAILER USE ID GEOLOGY INSPECTION _ NO SoeC. i�r1O'.vl. IJ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY IN SPECT.ION$$ Panic Devices I Hereby affirm that I am licensed under provisions of Chapter •;ISAFETY PERMIT tJ (LIST ITEMS BELOW) %0 9 (Commencing with Section 00) of Division 3 ?I the Busi- NO. OF EXITS ness and Professions Code. and my license is in :till force and j effect. ot PARKING REO'D 1 I PROVIDED N i 9P. CES License Number Lic. Class o — LIMITED TIME USE LL ,/(J y Contractor Date 'DATE DATE W Z 1 am exempt from the licensing requirements as I am a mI licensed architect or a registered professional engineers1zE OF moo. of INSPECTOR'S Z acting In my professional mracity Sezdon (iSi. Bus- EXISTING BLDG. STORIES SIGNATURE 9 inessaitdl'rotessionsCodel. FINAL APPROVAL O PRESENT USE OF BUILDING U Lic.or Reg.No. Date z I IU HOME OWNER-BUILDER DECLARATION NO. OF EXN?STING BUILDINGS ' t\ ON LOT AND USE 1 y•IV7 yV` I Hereby affirm that 1 am exempt from the Contractor's I License Law for the following reason (Section -031.5. Busi- ness and Professions Code): NO. PARKING I, as owner of the property. will do the work and the SPACES PROVIDED structure is not intended or offered for vile (Section I 704.4,Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCi' 1 hereby affirm that there is a construction lending agency N.A, Strx-,(, I for the performance of the work for which thil permit is ; issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. L..J Lender's.address I PERMIT FEE 25.00 I certify that I have read this application and state that the 011 � above information is correct.i agree to comply with!all County ISSUANCE FEE I'1 ordinances and State laws relating to buildirigg construction. and Hereby authorize representatives of this CounFy to enter TOTAL FEE 25-00 I uponqSi e- tinned property for inspection 9urposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE IN • ature of Permittee Date • ; i WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION CE 875(11-841 I hereby affirm [late I have certificate of consent tCOUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'rs'Compensation Insurance, e,,or or "� 2j a certified copy thereof(Sec.3800,Lab.C.). S,, 1 Policy No. Company FOR APPLICANT TO FILL IN wocR�ss J�j�� //. e� Certified copy is hereby furnished. S ABUDDRESSILDING 5665 N e LOCALITY 1 t D Certified copy is filed with the county building inspection X LOCALITY NEAFIEST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP TYPE CESSED BY CROSS ST. L!O� �{ CON F ` CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �+ � COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE[ STATE MAJOR SECOND LOCAL . (This section need not be completed if the Work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE OF t SIZE OF LOT RX[STING SLOG. I certify that in the performance of Elie work for which this = permit is issued. I shall not employ any person in any manner X OWNER K—Mart Corporation ® ' so as to become subject to the Workers' Compensation Laws. MAIL X OCCUPANCY GROUP _ ( Date Applicant ADDR£ss 3100 Bi Beaver Rd. _ NOTICE TO APPLICANT: If,after makin�a this Certificate of X "' Troy, TEL. OCCUPANT LOAD ; Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- I with comply with ;uch provisions or :Ills hermit dull be TRAILER USE j I GEOLOGY INSPECTION I_. No Spec. Knowl. deemed revoked. Panic Devices N LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION IS G' I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT [3 (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi_ NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REO'D O PROVIDED O y SPACES X License Number Lic. Class LIMITED TIME USE °' Contractor Date DATE DATE N _ y I -Rom: .O: ❑ 1 am exempt rrom -lie licensing requirements as I am a a ) licensed architect or a recistered professional anginev.- 31ZE OF YO.OF INSPECTOR'S acting in my professional capacity [Section "0:1. But; EXISTING BLDG. I STORIES SIG ATUR iness and Professions Code). b bAA � C' PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date_ x IU q HOME OWNER-BUILDER DECLAR.\f10N NO. OF EXISTING BUILDINGS ON LOT AND USEn I-` vl/ 1 hereby affirm that i am exempt from alae Contractor's ✓�• I License Law for the following reason tSection -031.5. Busi- ness and Professions Code): NO. PARKING [, is owner of dee property. will do the work •md :he SPACES PROVIDED structure is not intended or offered for ;ale ,Section 7044.Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING:SGL•\CY' I hereby affirm that there is a construction lending agency Consumer Lendinginside K—mart L ca I I for the performance of the work for which this permit is Cri r issued(Sec.3097,Civ.C.). Lender's Name �I PROPOSED MAX. OCC. [ Lender's Address � 1 PERMIT FEE 25.00 1•,,,,'� I certify that l have read this application and state that the p� above information is correct.!agree to comply with all County ISSUANCE FEE I'1 ordinances and State as relating to building construction. ,CO and lacrebv autho ' r sentativ.s of this Countv to enter TOTAL FEE 25.00 '•, I lbove- property for inspection purposes. =� j T, g� l I p e SEE REVERSE FOR EXPLANATORY LANGUAGE � O 11 b l0 iI,na T11,ir-riit;ce Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0211210002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 i PHONE: (626) 285-0488 EXT: LEGAL ID: NO" OF- CONST NEW --- BUILDING BK: 62 PG: 2 PC: SQ. FT STORIES TYPE OCCUP GROUP 5665 ROSEMEAD BL: STRUCTURE: 1 VN U1 TEMP CA 917801804 ASSESSOR -IN TIONI-NUMBEV. NEAREST CROSS STREET: LAS TUNAS 5387-031-059EXIST BLDG . THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: TENANT: ISSUED ON: PROCESSED DIVERSIFIED MKTG 8 PROMOTIONS BLDGS. NOW ON LOT: VALUATION: 11/22/02 JK 05/21/03 . 0 OWNER: TEL. NO: FINAL DATE F BY: CODE: ELTINGE GRAZIADIO;SAMPSON DEV CO - LIST ITEMS: �� en - - IDESCOIPTIONOF WORK TEMPORARY TENT FOR CAR SALE 11/21/2002 THRU 11/25/2002 OCCUP LOAD EXIST: APPLICANT: TEL. . OCCUP LOAD NEW: DIVERSIFIED MARKETING $ PROMOTIONS 2713 PARCO AVENUE PARKING SPACES REQUIRED: SPECIAL CONDITIONS: ONTARIO 91761 PARKING SPACES PROVIDED: EXIT HARDWARE: CONTRACTOR: TEL. NO.: LIMITED TIME USE NONE -LIC. NO NBR OF EXITS: FROM TO NONE FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPROiVALS DATE INSPECTOR SIGNATURE ARCHITECT 0 NG S - OA PERMIT ISSUANCE 27.75 LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFETY PERMIT TOTAL FEES 173.70 TEMP.,STRUCT. APPROVED MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP. STRUCT. REMOVED 0. OF FAMILIES: DWELLING UNITS: AP C : STAT CLXSS- NO 9CHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SETBACK FROMS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508